RISE Registration

RISE Registration

Resilience In Shared Experience (Sexual Violence Survivor Support Group)
Personal Identifying Information will not be shared
The next 8-Week RISE (Resilience In Shared Experience) Sexual Violence Survivor Support Group series will be held virtually (via Zoom) on TUESDAYS, October 15th - December 3rd, 2024, 6:00pm -7:00pm.

(To protect and maintain your privacy, registered participants will receive a new Zoom meeting invitation link via e-mail each week of the series.)
I will be attending:

IN PERSONVIRTUALLY
Preferred Name

First NameLast Name
How did you hear about RISE?
How did you hear about RISE?*

A New Leaf WebsiteFamily Advocacy CenterSocial MediaFlyer/BrochureOther
If Other selected, who?
Email*
example@example.com
City*
Phone Number

Area CodePhone Number
What is your preferred contact method?*
Age*
Gender Identity*
Pronouns
Race/Ethnicity*
If you choose to participate, what are your expectations of the group experience?
Attendance Preference:

In PersonVirtualEither
To help us continue to offer group opportunities that best meet survivors' needs, please check the box next to any area that interests you:

Groups: LGBTQ+ Survivors of Sexual ViolenceGroups: Secondary Survivors of Sexual Violence (family/friends/partners of primary survivor)Groups: Male SurvivorsGroups: Spanish/Bi-lingualRestorative YogaSound HealingOther
If Other selected, please state:
Do you have any individual needs or concerns that we should know about to provide you with the best possible experience?
Group Acknowledgement*

By checking this box, I acknowledge that this is a Psycho-Educational Group which focuses on education and support. This is not a therapeutic group.
Should be Empty: